[Anterior dislocation of the fibula resulting from surgical malreduction: a case report].

Ankle joint fracture is one of the most common types of fracture. There are many researches on the injury mechanism, treatment principles and surgical techniques. A type of injury which combines posterior dislocation of fibula, known as the Bosworth injury, is relatively rare. In 1947, Bosworth first described this type of injury as an unusual ankle fracture dislocation with fixed posterior fracture dislocation of the distal part of the fibula. In this type of fracture, the proximal fibular shaft fragment locks behind the tibialis posterior tubercle. This rare ankle fracture variant is often not recognized in initial radiographs and requires a computed tomographic (CT) scan for verification. But there are already many reports, discussing the injury mechanism, treatment principles and surgical techniques. However, there are few reports of anterior dislocation of the fibula, caused by either injury or surgery. The mechanism of the injury is still not clear. This article reports a case of anterior dislocation of the fibula. We report a patient with left ankle open fracture (Lauge-Hansen pronation-external rotation stage III, Gustilo IIIA). Open reduction and internal fixation was done in the initial surgery, but ended up with poor reduction, resulting in fibula anterior dislocation, anterior dislocation of talus and tibia fibular dislocation. The fibula was dislocated anteriorly of the tibia, which rarely happened. The patient suffered severe ankle joint dysfunction. The second operation took out the original internal fixation, reduced the fracture, and reset the internal fixation. The function of ankle joint was improved obviously after operation. But because of the initial injury and the two operations, the soft tissue around the fracture was greatly damaged. 6 months after the second operation, and the fracture still not healed, so the bone graft was carried out in the third surgery. Two months after the third surgery, the function of the ankle was significantly better than before, but the fracture healing was poor, which needed further review. Through this case, we understand the rare type of ankle fracture with anterior dislocation of the fibula, and recognize that the timing and quality of initial surgery has a great impact on the patient's prognosis and rehabilitation period.

Varus and internal rotational deformity of the ankle secondary to distal tibial physeal injury.

Nine children who sustained Lauge-Hansen's supination-inversion injury of distal tibial physeal injury with intact distal fibular physis, were followed until their maturity. The average varus deformity was 39 degrees (maximum, 80 degrees) with 23 degrees of internal rotational deformity. The longitudinal growth of the fibula was retarded compared with opposite normal leg. There was early closure of the medial distal tibial physis, gradual upward migration of medial malleolus, and eventually medial subluxation of the ankle; these resulted in gradual varus and internal rotational deformities of the injured ankle. It is thought that the resultant disabling deformity of ankle should be prevented by any means, though presently there are no available effective methods of treatment. It is suggested that the repeated corrective osteotomy should be carried out before epiphyseal deformity of the distal tibia and subluxation of the ankle joint develop.

[Progression towards dislocations of foot bone lesions in leprosy]. / De l'évolution vers la dislocation des lésions osseuses du pied du lépreux.

From a series of 211 tarsal, medio-tarsal and metatarso-phalangeal dislocations, the authors, after having recalled the lesion mechanism, adopted a classification and gave a place to preventive conservative surgery in 52 cases. The early forms can have early limited arthrodesia. The developed lesions present indications of arthrodesia--isolated reconstruction or associated to spongy or cortico-spongy bone grafts. The late forms impose amputation even when the forefoot seems of good bone quality because the metatarsal-phalangial stiffness is the cause for the failure of the Wladimiroff-Mickulicz interventions.

[Course of bone lesions of leprosic feet towards dislocation of the tarsus and metatarsus]. / Evolution des lésions osseuses du pied lépreux vers la dislocation du tarse et du métatarse.

The authors have observed 135 dislocations of the tarsus in leprosic feet. They recall the mechanism of the lesion and propose a classification. 42 cases were operated on to prevent further deformities. When early treated limited arthrodeses may be beneficial in some cases. In more severe cases rebuilding arthrodesis alone or associated to cancellous bone grafting is indicated. In very severe cases amputation is only indicated because the Wladimiroff-Mickulicz technique as well as grafts lead to failures related to the metatarsophalangeal joints stiffness.

[The pattern of injuries of the ankle joint in ski boots--a retrospective analysis]. / Das Verletzungsmuster des Sprunggelenkes im Skischuh--eine retrospektive Analyse.

This study is dealing with the analysis of isolated ankle fractures in ski boots which are nowadays very seldom. Modern equipment and excellent prepared skiing facilities reduced this kind of trauma. In the early sixties about 60% of lower extremity injuries were caused by ankle fractures. Now, 25 years later, only 10% of injuries concerning to lower extremity are injuries of medial and lateral ankle or of the talofibular ligaments. At the department of trauma surgery of the university hospital of Innsbruck we use a questionnaire for winter sports injuries. We made a retrospective follow up study of the last three years, in which we found 100 patients with ankle injuries. Pilon tibial- and tibia shaft fractures are not included. The classification was made by the Lauge-Hansen system. Supination-inversion and supination-eversion fractures were found more often than others. Fractures of both medial and lateral ankles were only seen in three cases. One reason for this result could be a lack of movement of the ankle in the ski-boot. Modern plastic boots seem to protect ankle and distal tibia and fibula. Another remarkable result was the fact that we could not find any difference in the types of fractures comparing patients with released and not released bindings.

Lauge-Hansen classification: a clockwork injury.

The purpose of this article is to present the Lauge-Hansen classification of ankle injuries, in a simplified system according to clockwork function. By familiarization with this classification system, one will gain an invaluable tool in evaluating and treating ankle injuries.